meeting report: fourth meeting of the ad hoc … image: gino carteciano, creative commons, via...
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FOURTHMEETINGOFTHE IACG OCTOBER2017
16-17October,2017
OIEHeadquarters,Paris,France
Meeting Report: Fourth meeting of the Ad hoc Interagency Coordination Group on Antimicrobial Resistance (IACG)
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TableofContentsABBREVIATIONS.........................................................................................................................................1
EXECUTIVESUMMARY................................................................................................................................3
1. INTRODUCTION..................................................................................................................................51.1. ABOUTTHEIACG...................................................................................................................................51.2. MEETINGAIMSANDOBJECTIVES...............................................................................................................7
2. AMRACTIVITIES.................................................................................................................................72.1. IACGACTIVITYMAPPING.........................................................................................................................72.2. MONITORINGANDEVALUATION(M&E)FRAMEWORK.................................................................................92.3. CALLTOACTIONCONFERENCE................................................................................................................10
3. IACGWORKPLAN.............................................................................................................................113.1. CO-CHAIRS’PRIORITIES..........................................................................................................................113.2. ADDRESSINGHIV,TBANDMALARIA(HTM)............................................................................................123.3. REFININGTHEWORKPLAN.....................................................................................................................133.4. COUNTRYVISITS...................................................................................................................................14
4. SUBGROUPS.....................................................................................................................................154.1. KEYFEATURESOFSUBGROUPS................................................................................................................15
5. REPORTING......................................................................................................................................175.1. DRAFTINGTHEIACGREPORTS................................................................................................................175.2. FINALDRAFTOFTHEWORKPLAN.............................................................................................................17
6. STAKEHOLDERSPOTLIGHT................................................................................................................196.1. IACGANDSTAKEHOLDERENGAGEMENT...................................................................................................196.2. STAKEHOLDERCONTRIBUTIONS:ANIMALHEALTH.......................................................................................20
ANNEXES..................................................................................................................................................23ANNEXI.MEETINGAGENDA................................................................................................................................23ANNEXII.LISTOFPARTICIPANTS..........................................................................................................................24ANNEXIII:SUBGROUPS......................................................................................................................................26
Imagecredits.Coverimage:GinoCarteciano,CreativeCommons,viaFlickr.AlliconsbytheNounProject(https://thenounproject.com/).
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AbbreviationsAMR AntimicrobialresistanceANMV FrenchAgencyforVeterinaryMedicinalProductsANVISA BrazilNationalHealthSurveillanceAgencyASEAN AssociationofSoutheastAsianNationsDNDi DrugsforNeglectedDiseasesinitiativeEMA EuropeanMedicinesAgencyFAO FoodandAgricultureOrganizationFEAP FederationofEuropeanAquacultureProducersGAP GlobalActionPlanonAMRHTM HIV,TBandMalariaIACG InteragencyCoordinationGrouponAntimicrobialResistanceIDF InternationalDairyFederationIEC InternationalEggCommissionIMS InternationalMeatSecretariatJEE JointExternalEvaluationLMIC Low-andmiddle-incomecountryNAP NationalActionPlanonAMRNGO NongovernmentorganizationOECD OrganisationforEconomicCo-operationandDevelopmentOIE WorldOrganisationforAnimalHealthR&D ResearchanddevelopmentSDGs SustainableDevelopmentGoalsTB TuberculosisUHC UniversalhealthcoverageUN UnitedNationsUNAIDS JointUnitedNationsProgrammeonHIV/AIDSUNEP UnitedNationsEnvironmentProgrammeUNGA UnitedNationsGeneralAssemblyUNICEF UnitedNationsChildren'sFundWASH WaterSanitationandHygieneWCO WorldCustomsOrganizationWHA WorldHealthAssemblyWHO WorldHealthOrganizationWIPO WorldIntellectualPropertyOrganizationWTO WorldTradeOrganization
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ExecutivesummaryDuringthe71stsessionoftheUNGeneralAssembly(UNGA),HeadsofStateissuedahigh-levelpoliticaldeclarationbackingaGlobalActionPlanonantimicrobialresistance(GAP)atnational,regionalandgloballevels.TheycalledontheSecretary-General(SG)toestablishanAdhocInteragencyCoordinationGrouponAntimicrobialResistance(IACG)toprovideguidanceonpracticalapproachestoaddressAMRandimprovecoordination,takingtheglobalplanintoaccount.Thisgroup,knownastheIACG,ismadeupof281high-levelexpertsandorganizationsinantimicrobialresistance(AMR)acrosshuman,animalandenvironmentsectors.InOctober2017,thegrouphelditsfourthmeeting.HostedbytheWorldOrganisationforAnimalHealth(OIE)inParis,thismeetingsawtheIACGshareupdatesonarangeofongoingactivities,agreeaplanforfutureworkandwaysofworking,developtheirworkthroughbreakoutsubgroupsessions,andengagestakeholdersfromthelivestockandanimalhealthsectors(seeAnnex1).
AMRactivitymappingTheAMRactivitymappingexerciseundertakenbytheIACGSecretariathighlightssignificantgapsinactivity,especiallyintheplanthealthandenvironmentspaceand,toalesserextent,intheanimalhealthsector.TheIACGagreedthatnextstepsforthemappingworkshouldinclude:• Possiblyexpandingthemappingtoincludeotherstakeholders,withintheUNfamilyandbeyond.• Re-mappingactivitiestotheFrameworkforAction2(includingallUNagencies,notjustIACGmembers).• Integratingotherrelevantdata,including,wherefeasible,commitmentsmadeattheCalltoAction.• Makingtheinitialresultspublicasworkinprogress,withlinkstofurtherinformation.• Usingtheresultstoidentifygapsandinformreportback onprogresstotheSGonnextsteps.
FinalisingtheworkplanTheIACG’sfinalworkplanincludesseveralchangesthatreflectfeedbackfromawebconsultation3ofMemberStatesandotherstakeholders,aswellasrecommendationsfromIACGmembers.Inparticular,theworkplanhasbeenrevisedto:• makerecommendationsmoreexplicit;• clarifythepurposeoftheFrameworkforActionandtheAMRmappingexercise;• strengthenlanguageabouttheIACG’sroleandaddedvalue;• includeareferencetoHIV,TBandMalaria;and• addressstakeholderengagement.Inadditiontofinalisingtheworkplan,IACGmembersfinalisedthedetailsofthreekeymechanismsfordeliveringthework:subgroups,countryvisitsandadraftinggroup(seeTable1).
1Threeseatsarecurrentlyvacant.2WHO2017.AMRFrameworkforAction(www.who.int/antimicrobial-resistance/interagency-coordination-group/20170818_AMR_FfA_v01.pdf?ua=1,accessed15October2017)3Onlineconsultation:InteragencyCoordinationGroup(IACG)onAntimicrobialResistance[website].(www.who.int/antimicrobial-resistance/interagency-coordination-group/online-consultation,accessed6November2017).
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Table1.AgreedmechanismsfordeliveringtheIACGworkplan
EngagingstakeholdersAllIACGmembersagreeontheneedtoengagethefullspectrumofstakeholdersincarryingoutitswork.TheParismeetinginvitedstakeholdersfromtheanimalhealthandfoodsectortooffertheirperspectivesonAMRandtosharetheirprioritiesforIACGguidance.Presentationsweremadebyrepresentativesfrom:InternationalDairyFederation,InternationalMeatSecretariat,InternationalEggCommission,InternationalPoultryCouncil,FederationofEuropeanAquacultureProducers,HealthforAnimals,andUSDAAgriculturalResearchService.TheirprioritiesforIACGactionandguidancearesummarisedinTable2below.Priority NotesTransparency • AtransparentmechanismforconsultingwiththeIACGContinuedengagement • AllowingstakeholderstostayinvolvedinIACGworkMorescienceanddata • Includingtheimpactofantimicrobialresiduesonhumanhealthanda
betterunderstandingofAMRtransmissionpathwaysMonitoringguidance • Awaytomonitorantimicrobialuse(includingtypeofagent)Education • RaisingawarenessamongbothconsumersandprofessionalsPublicinvestment • Overcomingregulatory,financialandtechnicalhurdlesAparadigmshiftinR&D • IncentivizingR&Dtoprimetheproductdevelopmentpipeline
• NotjustfocusingonnewproductsAportfolioofalternatives • Afocusonpracticalsolutionsacrossanimalproductionsystems,
includinggoodhusbandry,andstrongcapacity,capabilityandtraining.Table2.PrioritiesforIACGactionandguidanceidentifiedbystakeholdersfromtheanimalhealthandfoodsector
Mechanism Howitworks
Subg
roup
sSubgroupsofferawayofadvancingtheanalysisofspecificissues,anddevelopingpreliminaryconclusionsandrecommendationsthatcanfeedintotheIACG’splenarysessions. TheIACGhasestablishedsixsubgroups,closelyalignedwithitsFrameworkforAction:1. Communication,publicawareness,behaviour-change,professionaleducationandtraining2. Nationalactionplans,includingmonitoringandsupport3. Reduceneedforantimicrobialsandunintentionalexposure,andoptimisinguse4. Investininnovationandresearch,andboostresearchanddevelopment(R&D)andaccess5. SDGalignment,globalgovernancepast2019andUNroleandresponsibilities6. Surveillanceandmonitoringforantimicrobialusageandresistance Subgroupswillengageabroadrangeofexternalstakeholderstohelpinformtheirwork.
Coun
tryvisits CountryvisitshelpensuretheparticipationandbuyinofMemberStates.Theycanserveto
raisepoliticalawareness,recruitAMR‘champions’,roadtestIACGthinkingandgathercontext. AllIACGcountryvisitswillbe:short(1–2days);prepared(supportedbyastrongcountrybriefingbeforehand);andhigh-level(focusedonstrengtheningpoliticalwillandadvocacy;andonunderstandingcountrycontexttoidentifychallengesandinformrecommendations).
Draftin
ggrou
p ThedraftinggroupisdesignedtohelptheIACGwriteitsinterimandfinalreports.MadeupofasmallnumberofIACGmembers(subgroupchairs),thegroupwilluseinputsfrombothsubgroupsandthebroaderIACGmembershiptodevelopaninitialsetofwrittenguidanceandpreliminaryrecommendationsfortheIACGtoreviewandrefine.
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1. Introduction
1.1. AbouttheIACGIn2016,theGlobalActionPlanonantimicrobialresistance(GAP)4wasreaffirmedastheblueprintfortacklingAMRduringthe71stsessionoftheUNGA,whereHeadsofStateissuedahigh-levelpoliticaldeclaration5committingtosupportandimplementtheplanatnational,regionalandgloballevels.Throughthedeclaration,UNMemberStatescalledontheSecretary-GeneraltoestablishanadhocinteragencycoordinationgroupofexpertsuntilSeptember2019,toofferadviceandguidanceonhowtoaddressAMRandimprovecoordination,takingintoaccounttheGAP.Thisgroup,knownastheIACG,wasofficiallylaunchedinMarch2017.Itisco-chairedbytheUNDeputySecretary-GeneralAminaJMohammedandtheWHODirector-GeneralTedrosAdhanomGhebreyesusandcomprises28high-levelrepresentativesofUNagenciesandotherinternationalorganizations,andindividualexpertsacrossdifferentsectors.Thegroup’smandateistoprovidepracticalguidanceforapproachesneededtoensuresustainedeffectiveglobalactiontoaddressantimicrobialresistance;andtoreportbacktotheSG.Thisincludesmakingrecommendationsonhowtobettercoordinateactionacrosssectorsandcountries,andservingasavehicleforbuildingpoliticalmomentumandmobilisingabroadbaseofstakeholders.
TheIACGhasagreedasetofguidingprinciplesforitswork(seeIACGguidingprinciplesbelow)andhasdevelopedaFrameworkforAction6,whichincludes14‘contentareas’fortacklingAMR,six‘levers’foraddressingtheseandthreeunderlying‘enablers’(seeFigure1).Itoffersacommonlanguageforallsectorstouse.
4GlobalActionPlanonAntimicrobialResistance.Geneva:WorldHealthOrganization;2015(http://www.who.int/antimicrobial-resistance/global-action-plan/en/,accessed30October2017).571stSessionoftheUNGA.Politicaldeclarationofthehigh-levelmeetingoftheGeneralAssemblyonantimicrobialresistance(ResolutionA/RES/71/3).NewYork:UnitedNations;2016(http://www.un.org/en/ga/search/view_doc.asp?symbol=A/RES/71/3,accessed30October2017).6AMRFrameworkforActionSupportedbytheIACG.IACG;2017(http://www.who.int/antimicrobial-resistance/interagency-coordination-group/20170818_AMR_FfA_v01.pdf?ua=1,accessed30October2017).
AMR is a significant and growing threat—it needs this group’s expertise to help identify a collective and cohesive way forward. AminaMohammed,UNDeputySecretary-General,addressingmembersoftheIACGinOctober2017.
We have been working for years at the technical level… Now we have political support and we hope to keep this momentum alive so we can be stronger to support member countries design and implement effective national action plans. MoniqueEloit,OIEDirectorGeneral,addressingmembersoftheIACGinOctober2017.
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TheframeworkadoptedbytheIACG:• reflectsthekeyprioritiesandfocusoftheUN’shigh-levelpoliticaldeclaration;• isalignedwiththeGAP,buildsonitandsupportsitsimplementationacrosskeypriorities;• alignswiththeSustainableDevelopmentGoals(SDGs),manyofwhichwon’tbeachievedwithout
addressingAMR;and• framesAMRmeasuresasAMR-sensitiveandAMR-specific.
Figure1:TheIACG’sFrameworkforActioncovers14contentareas,sixleversandthreeenablers.Republishedfrom:WHO2017.AMRFrameworkforAction(www.who.int/antimicrobial-resistance/interagency-coordination-group/20170818_AMR_FfA_v01.pdf?ua=1,accessed15October2017)
IACGguidingprinciples• Ensuringthatpracticalapproachesarephasedandstepwise.• Ensuringthatrecommendationsarebasedonutilizationofexistingtoolsacrossorganizationsand
systemsthroughcollaborationandcoordination,andavoidingredundancy.• Noapportioningofblame,butworkingtoensurethattheAMRsituationgetsbetter,notworse.• Workingtosupportsystemsstrengthening,promotingthedisseminationofbestpracticesandcase
studies,andaccesstoservicesandhealthtechnologies.• CommittingtoaninclusiveandtransparentprocessbasedonGAPobjectivesandalignedwithSDGs.• Notduplicatingtheworkofothers.
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1.2. MeetingaimsandobjectivesInOctober2017,theIACGhelditsfourthmeeting.HostedbyOIEinParis,themeetingwaslargelyadecision-makingoneintendedtoprogressthegroup’swork.Themeetinghadfourkeyobjectives:a. Updateallmembersonongoingactivities.b. Agreeaplanforfutureworkandwaysofworking.c. Establishsubgroupsanddecidetheirmembership,scope,waysofworkinganddeliverables.d. Engagestakeholdersfromthelivestockandanimalhealthsector.
2. AMRactivitiesInclosedsessionsoftheParismeeting,IACGmemberswerebriefedonaselectionofkeyAMRactivities,includingtheIACG’sAMRactivitymappingexercise,theMonitoringandEvaluationFramework,theCalltoActionconference,theG20GlobalAntimicrobialR&DCollaborationHub,andtheintergovernmentalbodyCodexAlimentarius.
2.1. IACGactivitymapping
ActivityupdateAtitsfirstmeetinginMay2017,IACGmembersaskedthegroup’ssecretariattomaptheAMRworkalreadybeingdonebythetripartite(FAO,OIE,WHO),IACGmemberorganizationsandotherUNagencies.Thismappingwasintendedasafirststeptowardsunderstandingwhatactivitiesareunderway,whatdataarebeingcollected,andwherethegapslie.TheSecretariatdevelopedacategoricalframeworktomapactivitiesagainstthefiveGAPobjectives(plusacross-cutting‘strategicleadershipandcoordination’objective),whilecapturingadditionalinformation,suchasthenatureofactivities(strategicplanning,standards,operationalimplementation,advocacy),whatsectorthey’rein(human,animalorplanthealth,orenvironment),theirstatusandtheirrelevancetotheSDGs.
Todate,tenagencieshaveparticipatedinthemappingexercise.7ThemostchallengingaspectformostwasidentifyingasinglerelevantSDGbecausemanyactivitiesarerelevanttomultiplegoals.TheframeworkhasnowbeenrevisedtoallowmorethanoneSDGtobeselectedperactivity.
Usingthedatacollected,theSecretariatcreatedaseriesof‘maps’thatplot,foreachGAPobjective,thenatureofactivityagainstthesectoritliesin.Eachmapworksatahighlevel,seekingtounderstandwhattheAMRlandscapelookslike.TheSecretariat’sfindingsweresharedanddiscussedwithIACGmembersattheParismeeting(seeTable3andInsights,lessonslearnedandnextstepsbelow).GAPobjective Observations
GAP1Awarenessandunderstanding
• Planthealthandenvironmentsectorsarebehindontheseissuescomparedwithhumanandanimalhealth
GAP2Evidencebase
• TripartitecooperativeinitiativesactivelysupportnationalactionplansonAMRandmonitorandevaluatetheiroutcomes
GAP3Reducingincidence
• Thereisastronghumanhealthfocus• Theexactrelevancetoplanthealthandenvironmentishardtosee
7FAO,OECD,OIE,UNAIDS,UNEP,UNICEF,Unitaid,theWorldBank,WHO(plustheWHOHIV/TB/Malariateam),WIPO.
AMR is a cross-cutting issue that affects all the sustainable development goals.
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GAP4Optimisinguse
• Thereislotsofworkacrosshumanandanimalhealth,especiallyintheareaofstandards,guidelinesandbestpractices
GAP5Economiccaseandinnovation
• Thisareaistop-heavywithworkonstrategicplanningandcoordination• Itneedsadownwardspushtowardsstandardsandoperationalwork
Strategicleadershipandcoordination
• Therearesomecross-sectorstrategicleadershipinitiatives,butmorecomprehensiveonesareneeded,coveringplanthealthandenvironment
• Ongoingeconomicstudiesmayfeedintofuturestrategicleadership• Weexpectlotsmoreinformationfromotherorganizationsinthisarea
Table3:FindingsofAMRmappingexerciseinbrief. Insights,lessonslearnedandnextsteps
I. Themappingexerciseneedsvalidating• Acrossallobjectives,therearegapsin
activity,especiallyintheplantandenvironmentspace.
• Butarethesegaps‘real’?Areareassufficientlyresourced?There’smuchmoreactivityoutthereandvalidatingresults(byaddingactivitiesofotherstakeholdersandlookingcriticallyatgaps)isimportant.
• Themappingdoesnotincludecountry-levelactivities,whichmayexplaintherelativelylownumberofactivitiesinoperationalimplementationandadvocacyorpromotion.
• Tomoveforwardwithsubgroups,theIACGneedstomovebeyondhigh-levelinformationtoexaminethedetailsofwhatishappeningontheground,includinglookingatwhatcivilsocietyisdoing.
II. Themappingresultsarealreadyuseful;buttheycanbemademoreso
• TheIACGshouldexpandthemappingexercisetoincludeotherstakeholdersintheUNfamilyandbeyond.• Expansionincludesintegratingthecommitmentsmadeat
theCalltoActioninBerlin,andaddingothermappingactivities(particularlyonR&D,wheremappinghasbeendonebefore).
• ActivitiesneedremappingtotheIACGFrameworkforAction.• Toensuretheyare‘user-friendly’,mapsneedtobeflexible,andshouldincludelinkstomoreinformation.• Thesedatawillinevitablybeusedtoinformfinancialdecisions—thenaturalnextstepistolookathow
muchmoneyisbeinginvested,where,andwhatresourcesareavailable.
There are large areas with nothing—are there really no activities or is it that we simply haven’t identified any?
At the end of the day, we want a public-facing, online relational database.
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2.2. MonitoringandEvaluation(M&E)Framework
ActivityupdateWhentheWHAagreedtheGAP,italsocalledforthedevelopmentofamonitoringframework.OverthepasttwoyearsthetripartitehavedevelopedajointapproachtoM&EforAMRatcountryandgloballevels.Manyexpertswereinvolvedintheprocess,whichincludedapubliconlineconsultationin2017.Overalltheconsultationendorsedtheproposedapproachandapplaudeditsuseofamulti-sectoralframework,althoughmanyrespondentscalledformoreworktobedoneontheanimal,plantandenvironmentindicators.Workisnowunderwaytoincorporatethecomments,refinetheapproachandreviewandfocusthelistofindicators.BecausemanycountriesarestillonlyjustbeginningtodevelopanAMRresponse,M&Eoverthenextfewyearswillfocusonprogressasmuchas,ormore,thanonimpact.Tothatend,thetripartitehasalreadyconcludedaself-assessmentsurveytoidentify,amongotherthings,thestateofNAPdevelopmentandnationalsurveillancesystemsforAMR.ThetripartiteiskeenfortheIACGtoendorsetheapproach,assessGAPindicatorsandadviseonbothwhoshouldconsolidateandreviewglobalreporting,andhowevaluationshouldbecommissionedandfinanced.
Discussionhighlights I. TheIACGendorsestheapproachintheshort-term• TheIACGagreesthattheapproachwillworkforthenexttwoyears.• Thegroupwilldevoteasessionatitsnextface-to-facemeeting(Jan
2018)togetmoreinformation,discusstheIACG’spotentialroleintheframework,andexplorethelistofproposedindicators.
II. ThereisneedforacommonM&Eframework • TheM&EframeworkmustsupportanaccountabilitymechanismthatextendsbeyondtheGAP.• Thequestionishowtointegratethisintohigh-levelpoliticalforumprocesses?Theseprocessesstartat
thecountrylevel,sothatisthepointatwhichAMRshouldbeintegrated.
III. Theinformalmarketisabigunknown• Theindicatorwithgreatesttractionsofaristheratioofdrugswewanttohaveavailableagainstthosewe
wanttoconserve,whichiscalculatedbasedonwhatiscomingintoacountryatcustomslevel.• Butitalsoneedspointsurveysanddataontheinformalmarket,whichislargelyunknown.IV. TheM&Eframeworkisanopportunityformoredata• LackofaccesstodrugsisakeydriverofdiseasessuchasHIVand,assuch,isfundamentaltowhat’s
happeninginAMR:ifwedon’tmonitoraccesswemaymissabigpartoftheAMRstory.• Trackinghumanandlaboratoryresourceswouldbeuseful,albeithardtodoinpractice.• Understandinghowmuchisbeingproduced,whereandforwhatpurpose(whetherthatbedistributedby
doctorsorvets,mixedinfeedorusedoncrops,forexample)wouldbeamajorachievement.Butitrequiresthecooperationofpharmaceuticalcompaniestosharedata.
The country maps are a great achievement.
Pharmaceutical companies…are part of the solution.
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2.3. CalltoActionconferenceHeldinBerlin,October2017,theCalltoActionconferencewasaninnovativeeventaimedatacceleratingmomentum,alignmentandcooperationonAMR.TheeventwashostedbythegovernmentsoftheUK,GhanaandThailand,withWellcomeTrustandtheUNFoundation,inpartnershipwiththeIACG.ItwasdesignedtosupporttheIACG’swork.8Participantsincludedrepresentativesfromindustry,academia,NGOs,governmentsandfundingbodies.AllwerecalledontofocusonthemostcriticalgapsintacklingAMR,andtopubliclycommittoconcertedandtangibleactionstoaddressthese.Morethan60suchcommitmentsweremade,coveringarangeoftopicsfromtrackingglobalburdenofdiseasetodevelopingAMRtrainingcurricula.9ParticipantsalsomaderecommendationstotheIACGonwhatisrequiredtotackleAMR—rangingfromcontext-specificsolutionstoscientificstandards,R&Dincentivesandpublicawarenesscampaigns—whichwillinformtheIACG’sreportbacktotheUNSecretaryGeneral.
Insights,lessonslearnedandnextstep
I. CallstoActioncanhelptheIACGtapintoexpertiseandkeepmomentumhigh
• Thereisnoquestionthatthepoliticalcommitmentto
tackleAMRexists,butitisnotmatchedbyenoughconcreteactionontheground.
• Theconferenceheardanewcallforacceleration,withparticipantsaskingformoretohappen,andfaster.
II. Thenextconferenceneedsbroaderengagement• Despitemanyinvitations,participationfromtheglobalSouthwaslow.• Tobeinclusiveandmeaningful,thenexteventmustincludemoreparticipantsfromLMICs—theevent’s
successinBerlinshouldhelpsecurefutureinvolvement. III. Theseconferences,nowandinthefuture,candrivetheIACG’sworkTheCalltoActionconferencescanbeusedtodriveandsupporttheIACG’sworkby:• publishingalistofcommitmentstoholdpledgerstoaccountandkeeptrackofprogress;• usingmeetingstoreportbackontangiblepromisesnowand,fromthere,togeneratemorepromises;• integratingthecommitmentsintotheIACGmappingworktoprovideafullerpicture;• tailoringmeetingstospecificgapsoraudiences,andhostingconsultationsessionsforstakeholders;and• reinforcingtheroleoftheIACGtoconveneandcoordinate,ratherthanimplement.
8Oneoftheconference’sstatedobjectiveswasto“ensureweidentifyallongoingworkatanationalandinternationalleveltoinformtheIACG”.Seehttps://wellcome.ac.uk/news/global-call-action-drug-resistant-infectionsformoreinformation.9ThesearebeinganalysedbytheCalltoActionorganizingcommitteeandwillbeshared,infull,withtheIACGinduecourse.
[The Call to Action] offered a clear indication of the ocean of knowledge and resources out there.
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3. IACGworkplanTheParismeetingincludedseveralagendaitemsaimedspecificallyatfinalisingtheIACGworkplan.Groupmemberswereaskedtoreflectoncommentsmadebyco-chairs,respondentstothewebconsultationandcolleaguestodecidethefinalwordingoftheworkplan,definekeyactivitiessuchasstakeholderengagementandcountryvisits,andagreewaysofworking.
3.1. Co-chairs’prioritiesBothIACGco-chairsaddressedtheParismeetingtohighlighttheirprioritiesforthegroup.
AminaMohammed,UNDeputySecretary-GeneralSpeakingthroughavideoaddress,UNDeputySecretary-GeneralAminaMohammedpointedtofourareasofworkthatsheseesascriticaltothegroupfulfillingitsmandate:
a. Stakeholderengagement:buildingonthesuccessoftheCalltoActionconference,thisincludesconsideringhowtoleveragemeetingstomaintainbroadengagementacrossallstakeholders.
b. Cross-sectoralcommunication:thisinvolvescommunicatingmoreeffectivelyaboutAMRtothegeneralpublicandprofessionalsacrossthemedical,agricultural,environmentandfoodsectors.
c. Planofaction:thisincludesagreeingaclearlydefinedworkplantosteerthefutureworkofthisgroupandfinalisingawayofworkingthatcanfacilitatetheeffectiveimplementationofthisworkplan.
d. Countryvisits:thisincludesvisitingcountriestofindoutwhatisbeingdoneatnationalandcommunitylevels,andensuringIACGrecommendationsaregroundedinevidenceandcountryrealities.
DrTedrosGhebreyesus,WHODirector-GeneralWhenWHODirector-General,DrTedrosGhebreyesusaddressedthegroup,hemadeeightrecommendationsforactionintheimmediateandshortterm:
a. FillIACGvacancies:therearethreeIACGmembervacanciesthatneedtobefilledassoonaspossible.b. Proceedwithsubgroups:thesixproposedsubgroupsmakesenseandshouldbeadoptedimmediately.c. Enablesupport:theWHOiscommittedtosupportingtheIACGbutwantsthegrouptodefinethesupport
itneeds—thatmeanssubmittingaproposalforsupport,outliningpersonnelandresourcerequirements.d. Fundraise:thisbeginsbytheSecretariatputtingacosttoIACGactivitiesintheworkplan,preparinga
budgetandmakingalistofallpotentialdonorsandsupporters(forthegroupasawholeandsubgroups).e. IncludeHIV,TBandMalaria:WHOconsidersthatsomereferencetoHIV,TB,andmalaria(HTM)inthe
IACGworkplanisadvisable.LessonslearnedfromHTMcouldproverelevanttoresistanceelsewhere.f. Undertakecountryvisits:thisisimportanttoensurecountryparticipationandownership.g. Identifyinstitutionalcapacities:includetheseintheIACGAMRactivitymappingexercise.h. InvolvetheDirector-General:DrGhebreyesusiskeentobeinvolvedintheIACGasmuchaspossible,and
askedIACGmemberswhathecoulddotobestsupportthegroup(seeFigure2below).
Dr Tedros…and I are committed to giving you our full support as you survey the AMR landscape and formulate your recommendations.
AMR will be my top priority.
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Figure2:SuggestionsbyIACGmembersondifferentwaystheWHODirector-Generalcansupportthegroup. 3.2. AddressingHIV,TBandMalaria(HTM)The2017webconsultationontheIACGworkplanresultedinseveralcallsforspecificreferencetobemadetoHTM.10DuringtheParismeeting,IACGmembersreviewedtheprosandconsofdoingso.
Pros • Opportunityknocks.ThereareseveralmeetingsonHTMscheduledoverthenextyear(includingthe
UNGAhigh-levelmeetingonTBin2018)thatofferagoodopportunityforcementingpoliticalcommitmentto,andraisingtheprofileof,IACGwork.
• Lessonstolearn.HTMhavealonghistoryoftacklingdrugresistance,leadingthefieldintermsofbothprogrammesandfunding,andtheIACGcouldlearnfromtheirexperience.
• Agendaofthepoor.HTMarethethreebiggestinfectiousdiseasekillersofpoorpeople.IncludingthemiscriticaltomakingtheAMRagendarelevanttotheglobalSouth.
• Progressprotection.HTMhasmadelotsofprogressinthepast10–15yearsandAMRisputtingthatatrisksoweneedtokeepithighontheagenda.
10ForthelatestWHOinformationonresistanceinthesethreediseasessee:a)GlobalMalariaProgramme.Artemisininandartemisinin-basedcombinationtherapyresistance:StatusReportApril2017.Geneva:WorldHealthOrganization;2017(www.who.int/malaria/publications/atoz/artemisinin-resistance-april2017,accessed31October2017).b)Q&Aonartemisininresistance[website]Geneva:WorldHealthOrganization;2017(www.who.int/malaria/media/artemisinin_resistance_qa,accessed31October2017).c)Multidrug-resistanttuberculosis(MDR-TB):2016Update.Geneva:WorldHealthOrganization;2016(www.who.int/tb/challenges/mdr/mdr_tb_factsheet.pdf,accessed31October2017).
There’s a wealth of experience and expertise waiting to be tapped.
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Cons • Riskofimbalance.TheIACGmustmaintaina
balancedapproachacrosshuman,animal,plantandenvironment—addingHTMtotheworkplancouldgiveunduefocus:whynototherse.g.rabiesoravianflu?
• Holisticapproachundermined.TheIACG’sworkmustsupportAMRsystemsandaOneHealthapproach;notbedisease-specific.
• AligningwiththeSDGs.AlltheissuesneedtobestrategicallylinkedwithinthebroaderSDGframework,andHTMisalreadymentionedintheSDGs.
3.3. RefiningtheworkplanIn2017,theIACGinvitedinputonitsworkplanthroughawebconsultation,whichresultedinaround80responsesfromarangeoforganizations.Takentogether,theseresponseshadthreehigh-levelrecommendationstomaketotheIACG:• Keeptothelanguageoftheresolutionthatestablishedthisgroup.• DefinetheboundariesofwhattheIACGcanandcannotachievethroughitsmandate.• Developatimelinewithmilestonesfordeliveringtheworkplan.Beyondthesehigh-levelrecommendations,respondentsalsohadseveralspecificsuggestionsforimprovingtheworkplan.SotoodidseveralIACGmembers.ConsiderationofalltheseattheParismeetingresultedina‘todolist’ofninetasksaimedatrefiningtheworkplaninlightoffeedback.Theserangefromusingstronglanguagetoclarifythegroup’sroletodefiningstakeholderengagement(seeFigure3).
Focusonmandate
Identifyuseoftools
Thinklong-term
Referencede-linkage
Addvalue
Drawupabudget
ClarifyroleofIACG
Considerstakeholders
Buildatimeline
Figure3:A‘todo’listforrefiningtheIACGworkplaninresponsetofeedbackanddiscussion.
We have patients in front of us, not diseases: we need to address their needs.
As a group, the IACG needs to be strategic about how to situate the issue of AMR in the broader political context.
HTMoutcomeINCLUDEHTM,BUTDON’TMAKEITTHEFOCUSFollowingdiscussion,theIACGdecidedtoincludereferencetoHTMinitsworkplan,butnottomakethesediseasesthefocusoftheirwork.TheagreedreferenceismadeinObjective1.1oftheworkplan:“1.1AdviseonwaystomainstreamAMRactionintotheSDGs,inawaythataddressesantibacterialresistanceaswellasresistancetoantimicrobialsusedtotreatotherinfectiousdiseases,suchasHIV,TB,andMalaria(HTM).Usingasystemsperspective,theIACGwilltakeintoaccountHTMexperience,includinglessonslearnedinawareness,advocacy,andcommunityengagement,andwillseekopportunitiestocollaboratewithHTMinitiativeswhereappropriate.”• .
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3.4. Countryvisits
The‘why’:whataretheobjectivesofthesevisits?• TofulfilthemandatesetdownbytheUNSG,andsupportedbyIACGco-chairs.• ToengageMemberStatesatalllevels.• Toraisehigh-levelpoliticalawareness.• TorecruitAMR‘champions’(atbothcountryandregional
levels)thatcanextendthereachanddeepentheimpactoflocal,nationalandregionalAMRinitiatives.
• To‘roadtest’IACGthinkingandrecommendations.• TogathercolourandcontextfortheIACGfinalreport.• Tolearnaboutin-countrychallengesandopportunities.
The‘whatandhow’:whatwillavisitentailandhowwillitworkinpractice?
• AcountryvisitisanopportunityforIACGmemberstoseehowthetheoryofcombatingAMRworkson
theground,inthelocalcontext.• Visitsofferanopportunitytoreflectback
informationgatheredthroughdata-gatheringinitiativessuchastheJointExternalEvaluation(JEE)ortheOIEdatabase,inawaythatisusefulforcountriesindevelopingtheirNAPs.
• Allvisitsmustprovidesupportandencouragement;theyarenotcriticalassessments.
We’re trying to spark change but also to get country leaders to take their regions with them and build something bigger.
For countries that are struggling with the NAP process: how do we, as the tripartite or the IACG, support them?
CountryvisitsoutcomeUNDERTAKECOUNTRYVISITS,WITHAFOCUSONHIGH-LEVELENGAGEMENTIACGmembersagreedsuchvisitswouldbe:• short(1–2days);• prepared(supportedbyastrongcountrybriefingbeforehand);and• high-level(focusedonstrengtheningpoliticalwillandadvocacy).EachvisitshouldincludeaminimumofthreeIACGmembersandoneortwomembersoftheSecretariat.
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4. SubgroupsOnceIACGmembershadagreeduponafinalworkplan,theyconsideredhowtheywouldworktogethertoimplementit.Inparticular,theyagreedtheneedtosplitintosmallergroupstoadvanceanalysisofspecificissuesandchallengesanddeveloppreliminaryconclusionsandrecommendationsthatcanfeedintoIACG’splenarysessions.Tothatend,theIACGestablishedsix‘subgroups’,closelylinkedtotheFrameworkforAction(seeFigure6).AttheParismeeting,thegroupagreedthemembershipofthesesubgroups(seeAnnex3)anddefinedtheirscopeandaddedvalue,aswellaswaysofworking,includinghowtoengageexternalstakeholders.
Figure6.TheIACG’ssixsubgroups
4.1. KeyfeaturesofsubgroupsScopeSubgroupsareintendedtodrivetheIACG’sworkforward,andnottorepeatworkalreadybeingdonebythetripartiteorothers.Inmanytechnicalandpoliticalissuesthatthesubgroupswillgrapplewith,the‘what’hasalreadybeendefined,sotheywillfocusondetermining‘how’solutionscouldbeimplemented.RecommendationsonscopetoemergefromtheIACGdiscussioninclude:• Don’tduplicate.Subgroupsshouldnotduplicatework,
bothofotherorganizationsorothersubgroups.• Focusontheholes.Subgroupsshouldconcentratetheir
effortsonthecriticalgaps.
We must be informed by, but not re-do, the work of the tripartite.
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“• Ensureabalance.Subgroups’workshouldcutacrosshuman,
animal,plant,andenvironmentissues.• Alignwork.Subgroupsshouldlinktothecontentareas,
leversandenablersoftheIACGFrameworkforAction.• Keepaclearremit.Subgroupsshouldbeclearaboutboth
whattheyareandarenotdoing.
ExternaladvisorengagementAswellasIACGmembers,otherexpertsfromIACGmemberorganizations(referredtoasIACGtechnicaladvisors)willcontributetosubgroups.Subgroupsmayalsoconsultexternaladvisorsonspecificissues.However,inclusionoftheinputofthosenotaffiliatedwiththeIACGwillbecarefullyconsidered:allmembersofthesubgroupwillneedtoagreeontheinclusionofexternaladvisors,theseadvisorswillberequiredtoprovideaDeclarationofInterestbeforeengaginginIACGsubgroupwork,andtheirnamesandtypeofengagementwillbemadepublicontheIACGwebsite.Recommendationstoemergefromthediscussionsonengagementwithexternaladvisorsinclude:• Betransparent.Subgroupsshouldbeclearandtransparentaboutwhotheyareengaging,whenandhow.• Balanceexpertise.Subgroupsshouldselectexternaladvisorsfortheirexpertiseandexperience,adopting
aOneHealthapproachandensuringastrongbalanceacrossbothgenderandgeography.• Avoidconflictsofinterest.Subgroupsshouldfavourrepresentativesofassociationsratherthanindividual
organizations,toavoidconflictofinterests.• Limitroles.Subgroupsshouldlimitthefunctionsofexternaladvisorstoactivitiesandadvicewithinthe
subgroup(thatis,nodirectcontributionstothebroaderIACGgroup)toavoidtheriskofundueinfluence.• Consultwidely.Subgroupsshouldconsultwithabroadersetofstakeholdersoutsidetheroleof
advisors—through,forexample,webconsultations,interviewsetc.
DeliverablesEachsubgroupistaskedwithsubmittinga2–4pageanalysis,includingpreliminaryrecommendations,tothebroaderIACGgroupatitsnextface-to-facemeetinginBangkokinJanuary2018.Toensureaclearandconsistentfinalsetofrecommendations,IACGmemberswillneedtoagreeacommonlanguageandphilosophyforsubgroupstouseindraftingrecommendations—eitherattheJanuary2018meeting,orbefore.
Our added value lies at the political and strategic level.
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5. Reporting
5.1. DraftingtheIACGreportsTheIACGismandatedtoreporttotheUNSGduringthe73rdsessionoftheUNGeneralAssembly,andplanstoprovideitsfinalreporttotheSecretary-GeneralforSeptember2019.TheIACGhascommittedtoprovidinganinterimreportwithpreliminaryrecommendationsinSeptember2018;thegroupintendstoconsultwithMemberStatesonhigh-levelaspectsofthisinterimreportaheadofsubmittingittotheSecretary-General.Adraftinggrouphasbeensetup,comprisingthechairsofIACGsubgroupsandsomemembersoftheSecretariat,workingwithinputsfromtheIACGasawholetodevelopaninitialsetofguidanceandpreliminaryrecommendationsthatwillbesignedoffbyconsensusoftheIACG.ThedraftinggroupintendstomeetinApril2018todevelopafirstdraftoftheinterimreportfortheIACGface-to-facemeetinginJune.
Figure4:Draftinggroupmembershipandtimelineforreportdevelopment
5.2. FinaldraftoftheworkplanBeforetheParismeetingclosed,IACGmembersagreeduponafinalversionofthe2017–19IACGworkplan.KeychangesfollowingthewebconsultationandIACGdiscussioninclude:• Anewguidingprincipleonnotduplicatingtheworkofothers(seeSection1.1above).• Moreexplicitlanguageonensuringacohesive,integratedresponse(Objective1).• ReferencetoHTM(Objective1.1).• Moreexplicitreferencetoengagingwithstakeholders(Objective1.3).• ClearerstatementofintendeduseoftheFrameworkforAction(Objective1.6).• Moredetailedmappingactivitiessetout(Objective2).• Inclusionofadvocacyforinnovativefinancingmodels(Objective3.1).
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• Moreexplicitlanguageondeliveryofavisionandroadmap(Objective4).• ReferencetotripartitereportingassourceforassessingGAPprogress(Objective4.1).• DeletionofObjective5(whichwasagreedtobeawayofworkingratherthananobjective).• Minoreditsthroughouttoimproveclarityandsense.ThefinalworkplancanbefoundinfullontheIACGwebsiteat:www.who.int/antimicrobial-resistance/interagency-coordination-group/IACG-AMR_workplan.pdf.SeeFigure5belowforatop-leveltimelineofeventsandactivitiesassociatedwiththeworkplan.
Figure5:Timelineofmeetings,countryvisits,deliverablesandbroadersetofactivities.
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6. Stakeholderspotlight
6.1. IACGandstakeholderengagementAllIACGmembersagreeontheneedtoengagethefullspectrumofstakeholders,andontheneedforstakeholderstoengageeachotheronkeyissues.TheyaresimilarlyagreedontheneedtoensureaclearandtransparentprocessforengagingstakeholdersinIACGwork,andontheimportanceofcontextandculture.Thetoolsandtacticsthatworkforengagementwithonegrouporinoneregionmaynotworkforothers.Takingstakeholderengagementasagiven,thequestionremains:“whoarewetryingtoengage,whyandhow?”Thewho-why-howpuzzlesummarisesthescopeofthehigh-leveldialogueaboutstakeholderengagementattheParismeeting(seeFigure7below).
Figure7:Threeprongstostakeholderengagement
AMR can be context-specific, so we must remember that the messages won’t always have the desired impact unless they are rooted in context and tailored to different audiences.
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“6.2. Stakeholdercontributions:AnimalhealthAcrosstheworld,individualsandorganizationswithintheanimalindustryaremakingmajoreffortstocombatAMR.TheParismeetingprovidedanopportunityforIACGmemberstolearnaboutthechallengesandissuesfacedbythissectorandtohearrepresentativestalkabouttheirperspectivesonAMRandsharetheirprioritiesforIACGguidance(seeTables4and5below).Watchthestakeholderengagementsessioninfullatwww.youtube.com/watch?v=lWd8tGB6DNg.
6.2.1. LivestockKeystakeholdersPresentationsweremadebyrepresentativesfrom:
• InternationalDairyFederation(IDF):www.fil-idf.org• InternationalMeatSecretariat(IMS):www.meat-ims.org• InternationalPoultryCouncil(IPC):www.internationalpoultrycouncil.com• InternationalEggCommission(IEC):www.internationalegg.com• FederationofEuropeanAquacultureProducers(FEAP):www.feap.info
DiscussionhighlightsI. TacklingAMRinlivestockrequirescommunication,incentivesandregulation• Membershiporganizations,whichhavenoenforcementauthority,mustrelyongoodcommunication
toolstoinfluencebehaviourchange.• Successstoriescanbepowerfultoolsofpersuasion. • Theindustryneedsstrongregulation.• Incentivescanalsohelppromoteresponsibleuseandthe
privatesectorhasaparttoplayhere—largecompaniesareagoodvehicleformotivatinggoodbehaviourbyimplementinghighstandardsthroughtheirsupplychains.
II. Stakeholdersinthissectorareincrediblydiverse• Productionsystemsvaryinsize,speciesandlocalenvironment.• AddressingAMRwithinsuchdiversityrequiresacarefulbalanceofinterests.
III. Thesectorneedsacoordinated‘OneHealth’approach,rootedinscience• Inmanycases,theboundariesbetweenhuman,animal,
foodandenvironmentareveryblurred—especially,forexample,inaquaculture.
• CooperationacrossallsectorsiscriticaltosuccessintacklingAMR. • Anycooperativeapproachmustbefreeofblameandbias,rooted
inevidence,andbuiltoncomparabledata.
The first step in tackling AMR is often trying to explain in simple terms what it is and why it’s so important.
We want [cooperation] that is based on science—this is the common language that we all speak.
If you bring people to the table and build confidence, you get a lot more done.
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IV. Concertedeffortisrequiredto“leavenoonebehind”• Forlargecountry-basedmembershiporganizations,itcanbedifficulttoreachouttothe‘back-yard’
villageproductionsystemsthatexistinlargenumbersacrossLMICs.• Reducingantimicrobialuseresultsinchallengesandconsequencesthatvaryacrossdifferentcontexts.• WhateversolutiontoAMRisproposed,itmustconsiderthebillionpoorpeoplethatdependonlivestock
fortheirlivelihoodsaswellastheirnutritionalandfoodsecurity.• Changewilltaketimeandsoaphasedapproachmaybebest.Priority NotesTransparency • AtransparentmechanismforconsultingwiththeIACGAglobalview • Keepinginmindthat“whatwedoaffectseveryoneelse”Continuedinvolvement • AllowingkeystakeholderstocommentonIACGtechnicalcontentMorescience • EspeciallyontheimpactofantimicrobialsreleasedintheenvironmentMonitoringguidance • Awaytomonitorantimicrobialuse(includingtypeofagent)Table4:RecommendedprioritiesforIACGactionandguidancefromlivestockstakeholders
6.2.2. PharmaceuticalandthewiderR&Dagenda Keystakeholders Presentationsweremadebyrepresentativesfrom:
• HealthforAnimals:https://healthforanimals.org• USDAAnimalResearchService:www.ars.usda.gov/alternativestoantibiotics
DiscussionhighlightsI. Donotneglecttheenvironment • ThefateofproductsintheenvironmentisanimportantaspectofAMRthatdemandsrigorouscriteriafor,
andscrutinyof,manufacturingpractices.II. Focusonpracticalsolutions • Aportfolioofalternativestoantibioticsmaybe
neededtoachieveoptimumhealthanddiseasemanagementfordifferentanimalproductionsystems.
• Thereisscopeforimprovementwithbetterfeedandcontrol,butbiosecurityisnottheonlysolution.
“ We excel at preventive medicine and biosecurity, but animals will get diseases… so we must have tools to treat them.
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III. Adoptamulti-prongedapproach • ThereisacriticalneedtoincentivizeR&Dfornewantibioticsas
wellforalternativestoantibiotics,includingvaccines,especiallyforuseinagricultureandaquaculture.
• Atthesametime,betterregulationisneeded—toensurestrongveterinaryservices,legislation,counterfeitcontrols,andprescribingsystems.
Priority NotesScience-basedsolutions • Investinscience-basedinformationabouttransferpathways
• FocusenergyonactionstoreduceoverallAMREducation • Increasingunderstandingamongbothconsumersandhealthworkersof
howtouseantimicrobialscorrectlyandhowtohandleandcookmeatproducts
Publicinvestment • Investmenttoovercomeregulatory,financial,technicalhurdlestoanimalvaccination;andreinforcepublicveterinaryservices.
AparadigmshiftinR&D • IncentivestoprimeaproductdevelopmentpipelinethatiscurrentlydryAportfolioofalternatives • Managinghealthanddiseasesfordifferentanimalproductionsystems.Table5:RecommendedprioritiesforIACGactionandguidancefrompharmaceuticalandR&Dstakeholders.
We thrive under regulation because we are used to it.
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Annexes AnnexI.MeetingagendaFourthmeetingoftheInteragencyCoordinationGrouponAntimicrobialResistance(IACG)Venue:OIEHeadquarters,Paris Date:16-17October2017DAY1,16October08.30–08.45 Welcome08.45–09.15 DialoguewithDrMoniqueEloit,Director-General,OIE09.30–10.45 Updateson:CalltoActionconference;AMRmappingexercise;G20R&Dcollaborationhub
andGARD-P;UNGAsideeventonAMR;PresentationonCodex10.45–11.00 COFFEE 11.00–12.00 Presentationsanddecisionpoints:(1)M&EFramework(2)WorkplanlinkswithHTM12.00–13.00 WORKINGLUNCH:MeetingwithFrenchGovernmentonupdatetoNationalActionPlan13.00–14.30 Subgroups:Plenarydiscussion,followedbybreakoutsessionsforthesixsubgroups14.30–15.00 COFFEE15.00–15.30 SessionwiththeCo-chair,WHODirector-GeneralDrTedrosAdhanomGhebreyesus15.30–16.30 Plenarydiscussion:Synthesizingkeypointsfrombreakoutsession16.30-18.00 High-levelpresentationofworkplancomments18.00 Wrapupandcloseofmeeting18.30–20.30 CocktailreceptionhostedbyOIEDAY2,17October08.30–09.00 Welcomeandquickrecapofday1;run-throughofagenda09.00–11.00 Breakoutsession2:Grouptodivideintosub-groupsagain11.00–11.30 COFFEE11.30–13.00 Planfutureworkandmeetings,andfollow-updiscussionsonBangkokPMACmeeting13.00–14.00 LUNCH14.00–15.30 Presentationsbylivestockindustryrepresentatives,followedbyQ&A15.30–16.00 COFFEE16.00–17.00 PresentationsbyanimalpharmaceuticalandR&Drepresentatives,followedbyQ&A 17.00 Wrapupandcloseofmeeting18.30–20.00 High-levelstakeholderengagementeventatUKEmbassyinParis,France.
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AnnexII.Listofparticipants CO-CHAIRS MsAminaJMohammed DrTedrosAdhanomGhebreyesusDeputySecretary-General Director-GeneralUnitedNations(couldnotattend) WorldHealthOrganization MEMBERSDrHananBalkhyExecutiveDirectorMinistryofNationalGuardHealthAffairsKingdomofSaudiArabiaDrEnisBarisWorldBankUnitedStatesofAmericaProfessorOttoCarsSeniorProfessor,InfectiousDiseases,SeniorAdviser–ReACTSwedenProfessorJunshiChen*SeniorResearchProfessorChinaProfessorDameSallyDavies*ChiefMedicalOfficerUnitedKingdomofGreatBritainandNorthernIrelandDrLyalyaGabbasovaMinistryofHealthofRussianFederationRussianFederationMrMinelikAlemuGetahunWorldIntellectualPropertyOrganization(WIPO)SwitzerlandMsMarthaGyansa-Lutterodt*MinistryofHealthGhana
*Co-Convener
MrElliotHarrisUnitedNationsEnvironmentProgrammeUnitedStatesofAmerica(Couldnotattend)MsAnaHinojosaWorldCustomsOrganizationBelgium(Couldnotattend)MsJaanaHusu-KallioMinistryofAgricultureandForestryFinlandDrHajimeInoueWorldHealthOrganizationSwitzerlandMrMartinKhorSouthCentreSwitzerland(Couldnotattend)DrLuizLouresJointUnitedNationsProgrammeonHIV/AIDSSwitzerlandDrJuanLubrothFoodandAgricultureOrganization(FAO)ItalyDrMarcoMarzanodeMarinisWorldFarmersOrganization(WFO)ItalyDrLelioMarmora
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ExecutiveDirectorUNITAIDSwitzerlandDrGerardMoulinNationalAgencyforVeterinaryMedicalProducts(ANSES)FranceMrMarkPearsonOrganizationforEconomicCooperationandDevelopment(OECD)FranceDrStefanPetersonUnitedNationsChildren’sFund(UNICEF)NewYorkUnitedStatesofAmericaDrDonaldPraterFoodandDrugAdministrationUSA
DrJarbasBarbosadaSilvaNationalHealthSurveillanceAgency(ANVISA)BrazilDrMatthewStoneWorldOrganizationforAnimalHealth(OIE)FranceDrMarijkeWijnroksGlobalFundtofightAIDS,TuberculosisandMalariaSwitzerland(Couldnotattend)MsChristianeWolffWorldTradeOrganizationSwitzerland
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AnnexIII:Subgroups Forallsubgroups:technicaladvisorsandexternalstakeholdersengagedinsubgroupworkwillbeconfirmedinduecourseandlistedontheIACGwebsite. Subgroup1:Communication,publicawareness,behaviour-change,professionaleducationandtrainingMembersinclude:
• MsMarthaGyansa-Lutterodt,MinistryofHealth,Ghana(Chair)• DrHajimeInoue,WHO• MsAnaHinojosa,WCO
Subgroup2:NationalActionPlans,includingmonitoringandsupportMembersinclude:
• MsJaanaHusu-Kallio,MinistryofAgricultureandForestry,Finland(Chair)• DrMatthewStone,OIE• DrLyalyaGabbasova,MinistryofHealth,RussianFederation• ProfOttoCars,ReAct• MrElliotHarris,UNEP
Subgroup3:Reduceneedforantimicrobialsandunintentionalexposure,andoptimisinguseMembersinclude:
• DrHananBalkhy,MinistryofNationalGuardHealthAffairs,KingdomofSaudiArabia(Chair)• DrJarbasBarbosadaSilva,NationalHealthSurveillanceAgency(ANVISA),Brazil• DrJuanLubroth(FAO)• DrMarcoMarzanodeMarinis,WorldFarmersOrganization• ProfessorJunshiChen,ChinaNationalCenterforFoodSafetyRiskAssessment,China• DrGerardMoulin,ANMV,ANSES,France• MsChristianeWolff,WTO
Subgroup4:Investininnovationandresearch,andboostR&DandaccessMembersinclude:
• DrLelioMarmora,UNITAID(Chair)• MrMarkPearson,OECD• MrMinelikGetahun,WIPO• ProfessorDameSallyDavies,DepartmentofHealth,UK• DrMarijkeWijnroks,GlobalFundtofightAIDS,TuberculosisandMalaria• MrMartinKhor,SouthCentre,Switzerland
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Subgroup5:SDGalignment,globalgovernancepast2019andUNroleandresponsibilitiesMembersinclude:
• ProfessorDameSallyDavies,ChiefMedicalOfficer,UK(Chair)• ProfOttoCars,ReAct• DrEnisBarisWorldBank• MsNanaTaonaKuo,EOSG• DrLuizLoures,UNAIDS• MsMarthaGyansa-Lutterodt,MinistryofHealth,Ghana
Subgroup6:SurveillanceandmonitoringforantimicrobialusageandresistanceMembersinclude:
• DrDonaldPrater,USFDA(Chair)• DrLyalyaGabbasova,MinistryofHealth,RussianFederation• MrElliottHarris,UNEP